SARTESCHI AND DUBIN CLASSIFICATION

The blood vessels of the pampiniform plexus are usually no more than 1.5 mm in diameter.

CDUS is currently considered the gold-standard technique for varicocele assessment because it allows accurate diagnosis (with a sensitivity and a specificity close to 100%)


When a patient with a varicocele is examined at rest, multiple elongated, tortuous anechoic structures are seen above, around, or beneath the testicle 
 The vessel caliber thresholds used by different authors to define varicocele vary from 2 to 3 mm 

Under baseline conditions, blood flow may be too slow to be detected by CDUS, but during the Valsalva maneuver the varicocele enlarges and flow reversal becomes evident. Some authors suggest that varicoceles should also be assessed while the patient is standing.

Sarteschi classification 

1	Reflux in vessels in the inguinal channel is detected only during the Valsalva maneuver, while scrotal varicosity is not evident in the standard US study
2	Small posterior varicosities that extend to the superior pole of the testis. Their diameters increase and venous reflux is seen in the supratesticular region only during the Valsalva maneuver.
3	Vessels appear enlarged at the inferior pole of the testis when the patient is evaluated in a standing position; no enlargement is detected if the patient is examined in a supine position. Reflux observed only under during the Valsalva maneuver.
4	Vessels appear enlarged even when the patient is studied in a supine position; the dilatation is more marked in the upright position and during the Valsalva maneuver. Testicular hypotrophy is common at this stage.
5	Venous ectasia is evident even in the prone decubitus and supine positions. Reflux is observed at rest and does not increase during the Valsalva maneuver.

Dubin classification.

Grade	Features
0	Moderate, transient venous reflux during the Valsalva maneuver (physiologic findings)
1	Persistent venous reflux that ends before the Valsalva maneuver is completed
2	Persistent venous reflux throughout the entire Valsalva maneuver
3	Venous reflux that is present under basal conditions and does not change during the Valsalva maneuver

igure 1

Varicocele (A) with reflux in the vessels of the inguinal canal seen only during the Valsalva maneuver and (B) absence of varicosity on the standard US examination (A) (grade 1).

Varicocele with small varicosities (A) that exhibit reflux only during the Valsalva maneuver (B,C) (grade 2).

Figure 3

Varicocele with enlarged veins (A) whose calibers increase during the Valsalva maneuver (B) (grade 3).

Figure 4

Varicocele with enlarged veins (A) whose calibers do not increase during the Valsalva maneuver (B) (grade 4).

ref ---J Ultrasound. 2011 Dec; 14(4): 199–204.